Doctor Name: | DR. MICHAEL D. NICKELL |
NPI Number: | 1831185206 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | R9A40 |
Business Practice Address: | 2040 W. 32nd St Joplin, MO - 64804 |
Business Phone Number: | 4176271300 |
Business Fax Number: | 4176271357 |
Mailing Address: | 2040 W. 32nd St, JOPLIN |
State: | MO |
Postal Code: | 64804 |
Phone Number: | 4176271300 |
Fax Number: | 4176271357 |
NPI Enumeration Date: | 09/21/2005 |
NPI Last Update Date: | 04/17/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | R9A40 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |